Question

A client who has undergone radical neck dissection for a tumor has a potential problem of obstruction related to postoperative edema, drainage, and secretions. To promote adequate respiratory function in this client, the nurse should implement which activities? Select all.

A. Suction the client PRN
B. Encourage coughing every 2 hr
C. Low fowler's position
D. Support neck incision when coughing
E. Monitor respiratory status frequently

Answer 1

To ensure proper respiratory function post radical neck dissection, the nurse should suction as needed, encourage coughing every 2 hours, use a Low Fowler's position, support the neck incision during coughing, and monitor respiratory status frequently.

Step-by-step explanation:

To promote adequate respiratory function in a client who has undergone radical neck dissection, the nurse should implement several activities:

• Suction the client PRN (as needed) which could help remove secretions that the client may not be able to clear due to postoperative edema or weakened muscles.
• Encourage coughing every 2 hours to help clear secretions and maintain an open airway, thereby preventing possible obstructions.
• Position the client in a Low Fowler's position, which can aid in easier breathing and drainage of secretions.
• Support neck incision when coughing by providing gentle pressure to the area, which can help minimize discomfort and stabilize the surgical site.
• Monitor respiratory status frequently to detect any signs of respiratory distress or airway obstruction promptly for immediate intervention.